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Data-Driven Opioid Guardianship: A Health Care System's Blueprint for Change

The Opioid Guardianship program is a large-scale project spanning across Nebraska Methodist Health System focused on adhering to all opioid-related regulatory requirements and reducing unnecessary opioid prescription and usage.

Project Goals

  • Adhere to all related regulatory requirements
  • Reduce unnecessary narcotics prescribing and usage
  • Create a roadmap for the Opioid Guardianship Program

Primary Metric

  • Opioid prescribing at Discharge - Morphine Milligram Equivalent (MME)
       - Goals to be set after initial analysis complete

Secondary Metrics – used to guide individual improvement efforts

  • Inpatient opioid use
  • Multimodal usage
  • Patient education
  • PDMP utilization

Data Task Force Planned Actions

  • Additional analysis of opioid prescriptions per total prescriptions.
  • NMHS to benchmark against local/regional VA hospitals.
  • Total pills prescribed to dashboard.
  • Partnership with NeHii to further improve PDMP access and features.
  • Educate providers on best way to access and utilize the PDMP/PMP and better understand workflow issues.

Pharmacy Task Force Planned Actions

  • Create plans to operationalize new initiatives passed for CMS, MU, JC that may require PDMP review prior to opioid prescribing and EPCS.
  • Continue to work with Cerner for additional tools as well as investigate how to incorporate existing tools into the prescriber workflow.
  • Integrated MME calculator.
  • Investigate 2 prescription method for surgical patients to reduce leftover medications while addressing provider issues around weekend calls.
  • Investigate potential changes to pain management protocols.

Clinic Task Force Planned Actions

  • Tracking of PDMP use and policy. 
  • Standardizing location of pain contracts in EMR, renewal process, and maintenance policy.
  • PDMP education. 
  • Continue communication and education with high prescribing providers based on data dashboard.
  • Informatics support to set up favorites and PDMP access and MME calculator. 

Hospital Enhanced Recovery Task Force Planned Actions

  • Expanding Enhanced Recovery efforts across system.
  • Reduce opioid discharge Rx as appropriate.
  • Considering standardization of discharge narcotics based on type of surgery.
  • Continued investigation of alternative pain control medications and methods.

The Joint Commission Task Force Planned Actions

  • Addition of opioid education to patient discharge summary to help ensure education compliance.
  • Pain PI is revising comfort menu in order to make it easier and more accessible for nursing to utilize. 
  • Purchase and implementation of capnography equipment.
  • Review of opioid patient education compliance.

Community Task Force Planned Actions 

  • Continued partnership with Nehii. 
  • Continue to partner and educate throughout the region both within NMHS and interested community alliances.

Conclusion
Instituting a healthcare system-wide Opioid Guardianship Program required leadership support, project management, continuous improvement expertise, and creating an opioid database so as to develop a data-driven approach to institute change by identifying and reducing unnecessary prescribing and adhering to Nebraska LB 931.